University of Kentucky UKnowledge Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.) College of Public Health 2016 Incidence of Non-Hodgkin's Lymphoma by Residential Proximity to Superfund Sites in Kentucky: A Multivariate Analysis William Brent Webber University of Kentucky Follow this and additional works at: https://uknowledge.uky.edu/cph_etds Part of the Public Health Commons Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Webber, William Brent, "Incidence of Non-Hodgkin's Lymphoma by Residential Proximity to Superfund Sites in Kentucky: A Multivariate Analysis" (2016). Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.). 72. https://uknowledge.uky.edu/cph_etds/72 This Dissertation/Thesis is brought to you for free and open access by the College of Public Health at UKnowledge. 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William Brent Webber, Student David Mannino, MD, Committee Chair Dr. Wayne Sanderson, Director of Graduate Studies ABSTRACT OF CAPSTONE William Brent Webber The College of Public Health University of Kentucky 2016 INCIDENCE OF NON-HODGKIN’S LYMPHOMA BY RESIDENTIAL PROXIMITY TO SUPERFUND SITES IN KENTUCKY: A MULTIVARIATE ANALYSIS ABSTRACT OF CAPSTONE A Capstone project submitted in partial fulfillment of the requirements for the degree of Doctor of Public Health in the College of Public Health at the University of Kentucky By: William Brent Webber Student Name Lexington, Kentucky Director: David M. Mannino, MD Lexington, Kentucky Co-Director: Ramona Stone, PhD, MPH Lexington, Kentucky Committee Member: W. Jay Christian, PhD, MPH Lexington, Kentucky Copyright © William Brent Webber 2016 ABSTRACT OF CAPSTONE INCIDENCE OF NON-HODGKIN’S LYMPHOMA BY RESIDENTIAL PROXIMITY TO SUPERFUND SITES IN KENTUCKY: A MULTIVARIATE ANALYSIS Non-Hodgkin’s Lymphoma (NHL) is a category of cancers that arise from the lymphocytes of the immune system. The rates of NHL in the United States and Kentucky began to rise in the mid-20th Century, shortly after the manufacture, use, and disposal of numerous chemical substances began to increase during and after the Second World War. While the etiology of NHL is not fully known, there are several chemical substances for which evidence exists of a possible link between exposures and development of NHL and other cancers. Several of these substances are also present in sites within Kentucky designated by the US Environmental Protection Agency as hazardous waste sites under the Superfund program. The present investigation sought to determine whether residential proximity to Superfund sites in Kentucky was a significant risk factor for NHL. Geospatial coordinates for all Superfund sites in Kentucky were obtained, along with US Census 2010 population data at the census tract level, and de-identified data from the Kentucky Cancer Registry for all NHL cases between 1995 and 2012, including residential geospatial coordinates. Incidence data was calculated at the level of census tract, except for <5km buffer rings and 5-10km buffer circles around each Superfund site, whose NHL incidence data was calculated separately. Residence within the <5km and 5-10km buffer zones were the exposure variables, and other potentially relevant covariates were considered for the models, and tested for multicollinearity and significance. Because of spatial autocorrelation of NHL incidence data and non- stationarity uncovered during exploratory regression and diagnostics, geographically weighted regression was used in addition to ordinary least squares regression. Using the best-fitting models, it was determined that residence less than 5km and between 5-10km from the nearest Superfund site were both significant factors in elevated cumulative NHL incidence rates. The Beale Code for rural/urban characteristics of the census tract was another significant predictor, with more rural areas having higher NHL incidence rates. Directions for future research, public health implications, and potential strategies for distal and proximal interventions are presented based on the results of this study. KEYWORDS: Superfund, environmental exposures, non-Hodgkin’s lymphoma (Student’s Signature) William Brent Webber (Date) February 11, 2016 INCIDENCE OF NON-HODGKIN’S LYMPHOMA BY RESIDENTIAL PROXIMITY TO SUPERFUND SITES IN KENTUCKY: A MULTIVARIATE ANALYSIS By William Brent Webber 2016 __David M. Mannino______________________ (Signature of Capstone Director) (Date)___ February 11, 2016_____________ __David M. Mannino_________________ (Signature of Director of Doctoral Studies) (Date)___February 11, 2016_____________ RULES FOR THE USE OF CAPSTONE PROJECTS Unpublished capstone projects submitted for the Doctor’s degree and deposited in the University of Kentucky library are as a rule open for inspection but are to be used only with due regard to the rights of the authors. Bibliographical references may be noted, but quotations or summaries of parts may be published only with the permission of the author, and with the usual scholarly acknowledgements. 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Name Date ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ INCIDENCE OF NON-HODGKIN’S LYMPHOMA BY RESIDENTIAL PROXIMITY TO SUPERFUND SITES IN KENTUCKY: A MULTIVARIATE ANALYSIS William Brent Webber College of Public Health University of Kentucky ©2016 William Brent Webber ALL RIGHTS RESERVED TABLE OF CONTENTS PAGE LIST OF TABLES ................................................................................................. iv LIST OF FIGURES ............................................................................................... v ACKNOWLEDGEMENTS .................................................................................... vii CHAPTER 1: INTRODUCTION ............................................................................ 8 Background – Non-Hodgkin’s Lymphoma ................................................... 8 Background – Hazardous Waste Management Practices: United States .. 10 Statement of the Problem .......................................................................... 12 Purpose and Significance of the Study ...................................................... 14 CHAPTER II: LITERATURE REVIEW ................................................................ 17 CHAPTER III: METHODOLOGY ........................................................................ 25 CHAPTER IV: RESULTS ................................................................................... 32 CHAPTER V: IMPLICATIONS FOR PUBLIC HEALTH ...................................... 67 REFERENCES ................................................................................................... 75 APPENDICES Appendix 1: Institutional Review Board Approval Letter .................................. 90 Appendix